QUESTIONNAIRE FOR RESERVOIR APPLICATIONS

For CLEAN-FLO International to properly evaluate your project and do the best job possible in improving it, we need answers to the following questions.   Please answer them as completely as possible. If the information is not immediately available please answer as many as possible and a CLEAN-FLO representative will evaluate the information and contact you with further questions.

Project Name
Project Location
How did you hear about us?

Facility Owner/Operator/Manager

Company Name 
Street Address   
City State Zip
County/Parish Country    
Contact Name Position    
Phone No Fax No email

Consulting Engineer

Company Name 
Street Address  
City State 
 Zip
Country        
Contact Name Position    
Phone No Fax No email

Reservoir Information:

How big is the Reservoir? (Acres) Maximum Depth Average Depth    
What is the flow rate into the reservoir
How much water is pumped out per day cubic meters/day          
  YES NO If Yes, describe amount and frequency
Does the water level fluctuate?
Describe location of intake pipe. How far is it from bottom?    
  YES NO Please describe the pollutants
Does incoming water contain pollutants?
  YES NO Describe problem
Are there taste and Odor problems?
  YES NO Describe problem
Is there blue-green algae in the reservoir?
  YES NO Identify species
Do aquatic plants clog intake pumps and screens?

Please provide the following water
quality data for both surface and bottom of reservoir:

ITEM SURFACE BOTTOM ITEM SURFACE BOTTOM
Dissolved oxygen (mg/l) pH
B.O.D. (mg/l) Fecal coliform bacteria

(colonies/100 ml)
C.O.D. (mg/l) Total hardness (mg/l)
Total Kjeldahl Nitrogen (mg/l) Total alkalinity (mg/l)
Total phosphorus (mg/l) Phenolphthalein alkalinity (mg/l)
Ortho phosphorus (mg/l) Iron (mg/l)
Summer water
temp.° F		 Manganese (mg/l)
Winter water temp. ° F
Pollutants
What changes in reservoir water would help you to decrease the quantity of chemicals used to produce finished water?
Briefly describe your objectives?

Project Status:

  YES NO   YES NO
Preliminary Engineering/Design Budgetary Purposes
  YES NO      
Presently under Construction      
Other Status

Project Timing

Bid date if applicable When will aeration equipment be required on site ?

Approximate Budget

  YES NO If yes, specify.
Has funding been
appropriated for this project?

Electrical Service Available

Volts Phase Hertz Available power (amperes)

Please list any other useful information about the reservoir that you think would be useful:

Please send us any Questions or Comments below.